Aging and super-aging of society have become global concerns. As changes in physical and mental health often accompany aging, progressive aging is a global human health issue. Effective community care should thus be considered globally to gain insight into the prevention of caregiving for elderly people and the promotion of seamless care in medicine, prevention, and welfare. Innovation of community-based care is expected to improve not only the quality of life (QOL) of community-dwelling elderly people but also lead to a better community environment that contributes to healthy living among the younger generations, such as children and the working population. In this context, considering the health of the whole population by promoting health among the elderly will become increasingly relevant.

Each country is facing challenges specific to their own health policies and social changes. In Japan, the Draft Act on Amendatory Law to the Related Acts for Securing Comprehensive Medical and Long-Term Care in the Community came into effect in 2014 [1]. The Japanese Ministry of Health, Labour and Welfare proposed that an integrated community-based care system be established in each municipality by 2025, considering each community characteristic. This is expected to lead to the development of a truly effective, sustainable, and integrated community-based care system which takes into consideration the characteristics of community and promotes healthy living of community residents. However, the evidence of effective integrated community-based care appeared not to be enough worldwide. Evaluation items and outcomes of integrated community-based care need to be clarified and related findings are accumulated, considering the characteristics of community.

According to a previous literature review, 3 aspects of healthy living among community-dwelling elderly people can be considered outcomes of effective integrated community-based care: physical and social functioning, physical and mental health, and QOL [2]. In particular, it was suggested that social aspects need to be more focused on, considering the character of community environments such as urban or rural.

In additions, focusing on differences in environment between urban and rural communities as one of the characteristics of residential community, it has been suggested that social function and mental health or depression of elderly individuals might be more important as outcome measures of effective integrated community-based care [3]. And, it may be important for us to understand the associations between the defined social factors and mental health of community-dwelling elderly people, in order to consider the outcomes in the development of a truly effective, sustainable, and integrated community-based care system from the perspective of the community characteristics.

Various measurement tools are used to assess social aspects, as well as mental health. The social factors in a research need to be identified. In social aspects, focusing on social cohesion has been suggested as a way to gain a deeper understanding of social resilience, as well as for designing interventions for more sustainable and resilient systems [4].

Social cohesion may become one of the important social factors when considering how to further develop an effective and sustainable integrated community-based care system according to community characteristics, while taking into consideration social factors and the mental health of elderly people.

The purpose of this study was to explore the social factors and mental health-related scales, and to examine the associations between the social factors and mental health through a literature review, in order to consider the social aspects and mental health of the elderly as outcome measurements for an effective community-based care.

Electronic searches for English articles published in peer-reviewed journals up to October 2019 were conducted within PubMed, MEDLINE, and CINAHL, employing the following search terms: “social cohesion,” “mental health,” “elderly,” and “community.”

Identified articles were screened by title and abstract, and selected articles were subjected to full-text assessment and critical review according to the following 3 inclusion criteria: 1) studies conducted in community-dwelling elderly people or community-dwelling people including elderly people as participants; 2) studies with clear descriptions of social factors in the Methods section; 3) studies with clear descriptions of health-related items (e.g., mental health) in the Methods section. A narrative review was conducted in accordance with the present study objective. Same mental health-related scales used in each article were collected, and items with a similar meaning with regard to social function were assessed by collecting corresponding information from each article and perceived the social factors of community-dwelling elderly people. In addition, similar measures regarding social functions and mental health were assessed by collecting corresponding information from each article. Then, the associations between social factors and mental health of community-dwelling elderly people were examined.

In total, 118 articles were identified by the electronic search. After excluding 78 articles on the basis of title and abstract, 40 were selected, of which 11 met the inclusion criteria after full-text review; these were included in the final analysis (Figure 1).

Outline of the Research Articles

Table 1 summarizes data extracted from the 11 articles: 5 were published in 2018 [5] [6] [7] [8] [9], 2 were published in 2017 [10] [11], and 1 each was published in 2015 [12], 2014 [13], 2013 [14] and 2011 [15]. 6 of these studies were conducted in the United States [5] [6] [7] [9] [10] [11], 2 in the United Kingdom [13] [15], 2 in Japan [8] [14], and 1 in Taiwan [12]. The number of community-dwelling older people enrolled as participants in the 11 studies ranged from 149 to 19,656. 6 studies [5] [6] [8] [12] [14] [15] targeted individuals aged ≥ 65 years, 3 [7] [10] [11] targeted those aged ≥ 60 years, and 1 [9] targeted those aged ≥ 57 years; 1 [13] included participants aged ≥ 65 years in the study sample.

Mental Health-related Scales

6 mental health-related scales were used in the 11 studies: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) with 14 positively-worded statements [13] [15]; 15-item Geriatric Depression Scale (GDS-15) [8] [12] [14]; Center for Epidemiologic Studies Depression Scale (CES-D) [5] [9] [11]; Depression Scale-Anxiety (HADS-A) with 7 symptoms [7] [10]; Patient Health Questionnaire-9 (PHQ-9) [7] [10]; and Kessler-6 Psychological Distress Scale (K6) [6].

Social Factors of Community-Dwelling Elderly People

The following 4 factors related to social aspects of community-dwelling elderly people were perceived: neighborhood social cohesion, social capital, neighborhood environment, and social support. Neighborhood social cohesion was addressed in 8 studies [6] - [12] [15]. Social capital was addressed in 3 studies [5]